Guest Blog: When the Job Leaves a Mark: Understanding Psychological Trauma at Work

Guest contributor: Dr Judith Bird | Head of Mental Health Services, Medigold Health

Foreword from Mates in Mind

By inviting guest authors to share their thoughts, it does not necessarily mean that we share their view, but we do share their commitment to improve the impact of work on workers’ mental health and are keen to find opportunities for collaboration that will benefit those most at risk of suicide. So, please enjoy Judith’s blog and the thinking it provokes, and, if you would like to share your professional perspective, please get in touch. 

What psychological trauma is — and what it isn’t

In psychological terms, trauma is the response to an event that overwhelms a person’s capacity to cope — typically one involving actual or threatened death, serious injury, or violence. Crucially, the trauma is not the event itself. It is what happens inside the person in response to it. Two people can witness the same incident. One processes it and moves on. The other is profoundly affected for months. Neither response says anything about toughness or weakness.

Trauma can result from:

• A single, acute incident — an accident, an assault, a sudden bereavement.
• Cumulative exposure over time, common in emergency services, transport, and construction.
• Witnessing something happen to others or learning it happened to someone close.

Equally important: not every distressing experience is traumatic. A difficult redundancy or a workplace conflict can cause real psychological harm and should be taken seriously — but they are not trauma in the clinical sense. Conflating the two makes it harder to identify people who need targeted support.

Most people recover — and that is not an accident

Here is the most important thing to know — and the thing least often communicated: the majority of people who experience trauma will recover without developing a long-term mental health condition. In Europe, approximately two-thirds of the general population will experience at least one traumatic event in their lifetime, yet only around 5.6% of those exposed go on to develop Post-traumatic Stress Disorder (PTSD).

This is not luck, and it is not toughness. We are, as a species, built to process traumatic experiences. The brain’s job — its original, evolutionary job — is not to make you happy. It is to keep you alive. When something dangerous happens, it responds with everything it has:

• It replays the event to consolidate the lesson: this is what danger looks like — don’t get caught in it again.
• It keeps the nervous system on alert because, as far as the brain can tell, the threat might not be over.
• It generates fear, horror, grief and sadness — signals that something serious has happened and needs to be taken seriously.

None of this is malfunction. It is an ancient system doing exactly what it was built for. In most cases, given time, social support and freedom from ongoing threat, the brain reaches its conclusion — danger has passed, lesson learned — and the system stands down. The experience becomes part of a person’s history rather than their present.

There is something else worth understanding here because it comes up again and again in clinical practice. Many people going through these natural post-traumatic reactions don’t experience them as their brain and bodies working well. They experience them as evidence that something is wrong with them. The flashbacks feel like they’re “losing their mind”. The hypervigilance feels like weakness. The inability to “just get on with it” becomes a source of shame — even anger at themselves — and that creates its own spiral on top of an already difficult experience.

Whether or not someone experiences significant symptoms after a traumatic event is not a measure of strength or weakness. It is simply what that person’s nervous system needed to do to process what happened. As a manager, one of the most helpful things you can do is communicate this clearly.

When Recovery Stalls: The Range of Consequences

Most acute stress reactions settle within four to six weeks. When they don’t — when symptoms persist, intensify, or begin to significantly disrupt someone’s life — professional support makes a real difference, and earlier is better.

It’s also worth knowing that PTSD is not the only — or even the most common — consequence of trauma. More people will develop other difficulties than will develop PTSD:

• Depression — persistent low mood, loss of interest, fatigue, hopelessness. Frequently under identified in men, who may present with irritability or withdrawal rather than visible sadness.
• Anxiety disorders — including generalised anxiety and specific phobic responses. A worker who avoids a particular task, route, or site since an incident may be experiencing a phobic response, not PTSD.
• Substance use — alcohol use in particular increases after trauma, often as self-medication for sleep disruption or intrusive symptoms. WHO data shows lifetime substance use disorder rates are substantially higher in trauma-exposed populations. What begins as “a nightcap to help with sleep” can sometimes become a dependence.

These matter because they require different support interventions. PTSD treatment targets the specific intrusive, re-experiencing symptoms at the core of PTSD — and it won’t be as effective for depression or anxiety. Getting the right support to the right person requires good assessment and triage.

The next blog in this series (which will be published in June) covers PTSD specifically — what it is, how it’s diagnosed, and what effective treatment looks like. If you are supporting someone with persistent and severe symptoms following a traumatic event, that piece is worth reading alongside this one.

Which industries carry the highest risk?

Certain industries carry structurally elevated risk of trauma exposure. If your organisation operates in one of these sectors, trauma often isn’t a rare exception — it’s a foreseeable occupational hazard:

• Construction and civil engineering — a systematic review found 7–11% PTSD prevalence, but 10–38% depression and 19–42% anxiety in the sector. Fatal incidents are more common than in most industries, and workers are frequently first on scene.
• Transport and logistics — road fatalities, including incidents involving pedestrians, are sadly a routine occupational hazard for professional drivers. Disclosure in this sector remains particularly low.
• Emergency services and utilities — European research consistently finds PTSD prevalence ranging from 8% in firefighters to over 20% in emergency department and psychiatric nursing staff.
• Offshore energy — severity of incidents combined with geographic isolation limits access to timely support when it is needed most.
• Manufacturing — serious accidents are less frequent but can be devastating, particularly in close-knit teams where everyone knew the person involved.

The Mates in Mind programme recognises a compounding factor across these sectors: male-dominated industries with cultures that have historically discouraged emotional disclosure, create an environment where high trauma exposure meets limited outlets. That combination is precisely where untreated trauma takes root.

What your organisation can do

The single most important thing you can do is have a clear, transparent plan before anything happens. When someone is in the acute phase after a traumatic event, their nervous system is already struggling. Knowing what support is available, and what happens next, provides a sense of safety and control at exactly the moment it is most needed. Uncertainty compounds distress. Predictability protects against it.

Protect the four-to-six-week recovery window

This is the critical period for natural recovery. Manage workplace demands during this time: reduce workload where possible, review shift patterns that fragment sleep, and avoid adding stressors onto someone who is already at capacity. The goal is not to remove someone from work entirely — returning to routine can genuinely support recovery — but to ensure the workplace isn’t actively working against it.

Check in regularly — but don’t debrief

Regular contact signals that the person hasn’t been forgotten. But the purpose of checking in is not to encourage them to recount the event. Most people don’t need to talk through what happened in detail, and some find it counterproductive. “How are you doing?” and “Is there anything we can adjust to make things easier?” are more useful than anything that returns focus to the incident itself. Aim for check-ins at two weeks, four weeks and eight weeks.

Make support genuinely accessible

People should know — before anything happens — that occupational health or counselling support is available if they want it. Not mandatory. Not decided for them. But clearly available, with a simple pathway and no professional stigma attached. Communicate it proactively after an incident and follow up to make sure people have actually been able to access it, not just received a leaflet.

Avoid mandatory group debriefs in the immediate aftermath

Peer support and informal connection are valuable and should be encouraged. But structured, mandatory psychological debriefing sessions in the hours or days after an incident are not supported by the evidence and can, in some cases, consolidate distress rather than reduce it.

Train your managers to notice change

You don’t need to diagnose anything. You need to notice when someone isn’t themselves — particularly following a known difficult event — and be willing to have a simple, human conversation. That is often the most important intervention of all.

Dr Judith Bird is Head of Mental Health Services at Medigold Health, a national occupational health provider. She holds a doctorate in clinical and health psychology and has worked across public and private sector mental health services for approximately 20 years.

LinkedIn: www.linkedin.com/in/dr-judith-bird 

Next edition: When Trauma Doesn’t Resolve — Understanding PTSD at Work.

References

1. Wittchen H-U, et al. (2011). Trauma and PTSD in Europe. In Post-Traumatic Stress Disorder. Oxford University Press. https://academic.oup.com/book/24487/chapter/187582261
2. Koenen KC, et al. (2017). Posttraumatic stress disorder in the World Mental Health Surveys. Psychological Medicine, 47(13), 2260–2274. https://pmc.ncbi.nlm.nih.gov/articles/PMC6034513/
3. Bharat C, et al. (2022). The associations between traumatic experiences and subsequent onset of a substance use disorder: findings from the WHO World Mental Health surveys. Drug and Alcohol Dependence, 236, 109489. https://www.sciencedirect.com/science/article/abs/pii/S0376871622003118
4. Vijendran M, et al. (2024). A review on the prevalence of poor mental health in the construction industry. International Journal of Environmental Research and Public Health, 21(3), 276. https://pmc.ncbi.nlm.nih.gov/articles/PMC10930880/
5. Berger W, et al. (2020). Rescuers at risk: posttraumatic stress symptoms among police officers, firefighters, ambulance personnel, and emergency and psychiatric nurses. Frontiers in Psychiatry, 11, 602064. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2020.602064/full